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Critical Global Health: Evidence, Efficacy, Ethnography
Addicted, Pregnant Poor
For the addicted, pregnant, and poor women living in daily-rent hotels in San Francisco's Mission district, life is marked by battles against drug cravings, housing debt, and potential violence. In this stunning ethnography Kelly Ray Knight presents these women in all their complex humanity and asks what kinds of futures are possible for them given their seemingly hopeless situation. During her four years of fieldwork Knight documented women’s struggles as they traveled from the street to the clinic, jail, and family court, and back to the hotels. She approaches addicted pregnancy as an everyday phenomenon in these women's lives and describes how they must navigate the tension between pregnancy's demands to stay clean and the pull of addiction and poverty toward drug use and sex work. By creating the space for addicted women's own narratives and examining addicted pregnancy from medical, policy, and social science perspectives, Knight forces us to confront and reconsider the ways we think about addiction, trauma, health, criminality, and responsibility.
320 pages, Kindle Edition
First published October 30, 2015
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Displaying 1 - 16 of 16 reviews
November 14, 2017
Really drives home how sociopathic jokes about "crack wh*res with babies on welfare" are.
December 5, 2020
Book Review:
Knight, Kelly Ray, addicted. pregnant. poor.
Durham, NC: Duke University Press, 2015
Reviewed by Darra Rochelle Crouch
Kelly Ray Knight’s “addicted. pregnant. poor.” provides a compelling narrative ethnography examining the lives of the women living and working in the daily rent hotels of the Mission District of San Francisco. Intimate and brutal at times, Knight is frank and unflinching in her writing. Knight has not written a typical ethnography. What makes this book exceptional is Knight’s ability to weave the gut-punching exposure of social and political failures, next to her thoughtful self-aware discourses where she questions her own anthropological practice. Knight calls out the vulturistic aspects of the ethnographer, but she reminds the reader that it is not the vulture who kills their prey. (pg. 23). The real killer, as Knight illustrates, is the slow-moving and destructive power relationships that exist in between the world of the addicted pregnant and poor women that we meet in the day rent hotels of San Francisco and the world everywhere else.
Knight steps away from the high tower of academia and inserts herself into the narrative she composes. She is unafraid to share her own emotions about her experience and the way it pressed into her on a personal level, while still delivering a deep and wide theoretically salient work. Knight’s capacity as a researcher and her ability to communicate across a broad spectrum of institutional, organizational, and forbidden worlds, is made obvious throughout the book and her field notes provide an almost animated quality to each chapter. Translating her findings into a piece of scholarly work that does not feel overly filled with jargon, Knight provides essential information about the social, economic, political, public health, gendered, sociological, and critical nature of her study. The chapters and passages do not trip or stumble as they shift between the painful and brutal world of the daily rent hotels, the sober interactions with clinicians and public support workers, and Knight’s own musings about where she herself fits into the story.
The dichotomies that addicted, pregnant and poor women confront regularly represent a broad theme throughout the book. A common thread seen often in poverty research is the concept of the “deserving versus the undeserving” poor. This discriminatory practice is often reserved for populations of color, especially women, but Knight’s study, shows that the morally righteous are happy to discriminate across racial lines when women are pregnant and addicted.
Welfare qualifications have included some form of social control of women’s behavior for a long time. (Katz PPT) The women in Knight’s study face discrimination based upon their deviant behavior, specifically, drug use, the unstable living situation as well as involvement in sex work. Knight demonstrates, as so many other studies have, that welfare reform and the multiple changes since the original act in 1996, may very well have taken people off the welfare rolls, but only to leave them in situations that are worse, not better. (Gutman, Ketterlinus, and Mclellan. 2003.) The social safety net, in its current neoliberal form, has become a subtle system of “forced” coercion, in which non-compliance triggers punishment. The promotion of self-reliance in a system that points you towards choosing a rock or a hard place as your only two options for success will never be a winning program, no matter how much the policymakers congratulate themselves. (Morgen and Gonzales. 2008.) The fragility of trying to maintain self-reliance on a mid-20th century minimum wage paycheck, in the 21st-century world, does not require a degree in economics to understand. Yet the past decades of policy expect the people of this country to simply look the other way and accept the language about who is deserving.
While the efforts to have us believe that there exists, a newly minted cohort of self-sufficient citizens fresh off the welfare rolls on a regular basis may not be the worst crime of the neoliberals, it is undoubtedly the most tone-deaf. (Morgen and Gonzales. 2008.) Not only has poverty increased under these policies, but the middle class has all but disappeared, and the population living in deep poverty has expanded. Knight may not directly address welfare head-on, like Edin and Shaefer’s “ 2.00 a Day, Living on Almost Nothing in America” or even Katz’s “Reformed American Dreams,” but she doesn’t have to, her subject matter is a direct result of these policies.
In the most extreme poverty, even the tightest relationships are under tremendous strain. Circumstances of poverty create scenarios that weaken every area of Maslow’s hierarchy of needs. The addicted pregnant and poor women of the mission district show the ways that long stretches of this kind of living push people into the margins. For many of the women Knight works with, trauma begins in their own families, often at a very young age. (Savage and Russell. 2004) The outcomes of sundered lives may not always result in stories like the women in Knight’s book, but it is not uncommon to see how breakdown of early family relationships play a part in the inability to create meaningful relationships and the continued patterns of harm and mistreatment. Networks of the other women in the day rent hotels or other areas of street life can feel like a support system that the addicted, pregnant and poor women have, but typically, it is the network of people on the street that make it harder to escape. (Walsh et. al 2014)
Once separated from a secure form of housing, a stable family unit, fictive or otherwise, vulnerability and dependency is a constant threat. No one wants to be in that situation, and the women who live in the daily rent hotels, fight the worst living conditions every day and work to earn their rent, for just the slimmest margin of security and have to wake up and do it all over again the next day. Addiction and pregnancy are only two of several physical and mental issues that are part of the daily needs of the women in the day rent hotels cope with daily. The struggle to find and access proper help, the fight against wanting help, the fear of institutions, and the convoluted and disorganized thinking (pg. 194) creates additional barriers that often make getting through each day much more challenging than it already is. (Hansen, Bourgois, and Drucker. 2014)
The need for access to healthcare and housing security as a result of pregnancy presents Knight with a direct link to the complex ways in which the women are at the mercy of a system that judges them as morally bankrupt. (Leon and Shdaimah. 2012) Knight is able to speak with many of the “neurocrats” or advocate/bureaucrats (pg. 103) who help the pregnant, addicted, and poor women get the benefits they need. Some of the changes to welfare since 2000 have made changes to the qualification for certain SSI benefits. These “neurocrats” assist women in getting through the paperwork in such a way that prioritizes their mental health diagnosis so that they can qualify for the benefits.
The permanent “label” of a mental health disorder attached to one’s record is something that gives pause. How will this affect the future? Will this diagnosis become a scar, a permanent mark on the record of their failure, rather than a pathway towards receiving help? Will having this mental health diagnosis change the way authorities see a potential mother on paper? Even though many of these women are using drugs well into their pregnancies, they still anticipate wanting a relationship with their babies. It is natural to wonder how a mental health diagnosis will make them look as a mother.
The weight of this reality is something that Knight feels, she describes a conversation with a good friend, associate, and “long time interlocutor” who asks her about her feelings when she is with these women as they are using drugs while pregnant, Knight confesses, rhetorically, that she would like to kill them. Still, Knight is not a killer, no, she is just a vulture. (pg.231)
Having spent more than a decade doing outreach with the addicted populations in the San Francisco metro area, Knight is at ease with this understanding of how addicts behave and talk, her casual conversations with these women speak to her lack of judgment. The candid nature in which Knight’s subjects behave with her, make it clear that they feel comfortable and at ease. Knight captures the traumatized, demoralized, and criminalized victims who are frequently incapable of seeing far enough into the future to understand that there is an alternative to what is happening.
Compartmentalized by temporal frameworks, is one of the ways Knight uses to describe the lives of the addicted pregnant and poor woman. . Knight discusses the following frameworks for “time” in the lives of these women; addict time, hotel time, pregnancy time, jail time, treatment time, epidemiological time, biomedical time, memorial time, and lifetime. These time frameworks are both physical and mental, real and conjured, and each contributes to the disordered way these women live their lives. Yet, these temporal frameworks, additionally serve to provide the only sense of actual order for many of these women.
So much of what Knight punches at throughout the more narrative aspects of this ethnography feels to me like the binary ideas of Claude Lévi-Strauss’s adaptation of Structuralism. Knight presents you with these creations generated out of a response from the growing homelessness in San Francisco; the private daily rent hotel and the government-sponsored Single Room Occupancy (SRO) hotels. Structurally both hotel options may have started with the same purpose; however, for the women in her book, Knight illustrates how these binary options deliver another rock and hard place option for many women living on the razor’s edge. The government-sponsored option is a safer option, and it provides freedom from many of the injustices the women face at the daily rent hotels. However, the government-sponsored SROs are strict, you must pay rent one month in advance, often there are waiting lists, and SRO means what it says. Some may have curfews, there is less freedom, and Single Room Occupancy means what it says. The daily rent hotels offer a kind of day to day freedom that is sometimes easier to handle mentally and emotionally when your minds can only think as far as the next hit. The choice can be difficult.
A macro-level dichotomy that Knight points out is the view that the women in the daily rent hotels are both victims and perpetrators. Closely connected to the idea of the deserving and undeserving poor, the embodiment of both victim AND perpetrator for the pregnant addicted women presents a unique and challenging problem sociologically. The public’s mistaken understanding that anyone would choose to become an addict is problematic; one cannot possibly dictate rules about something of which they do not know. The “welfare to work” part of the welfare reform act has done nothing to help women “get back to work” in any meaningful way. The neoliberalist agenda, which promotes this work first ideal, does not seem to have any interest in the actual success rate for any of the people they claim to be helping. (Leon and Shdaimah 2014). When challenged regarding the number of people who are still suffering under the current policies, lawmakers are very quick to assign blame to the victims for being lazy.
Organizations like Project Prevention takes advantage of these vulnerable populations, by offering cash to women who are willing to consent to long term or permanent sterilization. This type of stratified reproduction (pg. 153), a horrifying specter of eugenics, and yet there is something fantastically sellable about Project Prevention’s package. At a minimum, the concept of getting paid to use contraception seems more empathetic than the welfare policies that currently exist.
That said, I need to express that even typing those words made me feel dirty. The exploitation of an addict’s need for money presents a challenge to my understanding of ethics. Expressly because, as a sober addict myself, I know how the addict’s mind works.
But I am not surprised that organizations like Project Prevention exist. The marketability of Project Prevention’s tactics and the current neoliberal policies are highly appealing to a specific sector of the population. But none of the practices of the “welfare to work” policies and how they are structured are based on evidential research, the methods of the neoliberals are based only on confirmation bias and a feedback loop of rhetoric. ( Morgen and Gonzales. 2008) Like so many aspects of the lives of the addicted, pregnant, and poor woman, everyone has an opinion, and many people are not afraid to tell you what they think is best. No one ever thinks to ask the women who are living in the conditions of being poor and addicted and pregnant what they think.
Knight shows all this complex and emotionally intricate subtext by using her field notes as a preface to each chapter and interjecting her person as a character as part of the narrative. By providing so many professional and clinical voices of the people who work in the world that the pregnant addict and poor women travel in, Knight provides an essential read for sociology and anthropology students as well as anyone interested in gender issues or policy. Having gone with Knight on this journey, I feel armed with a perspective that is clear and informed and rooted in an even-handed balance of academia and humanity. What researcher would not want to give that gift to their reader?
REFERENCES
Amundson, Kalynn, Anna M. Zajicek, and Brinck Kerr. 2015. “A Social Metamorphosis: Constructing Drug Addicts From the Poor.” Sociological Spectrum 35, no. 5:442–64.
Gutman, Marjorie A., Robert D. Ketterlinus, and A. Thomas Mclellan. 2003. “Characteristics of Substance Abusing Women on Welfare: Findings from the Evaluation of CASAWORKS for Families Pilot Demonstration.” Evaluation Review, 27 no. 6: 597–628.
Hansen, Helena, Philippe Bourgois, and Ernest Drucker. 2014 “Pathologizing Poverty: New Forms of Diagnosis, Disability, and Structural Stigma Under Welfare Reform.” Social Science & Medicine, 103: 76–83. https://doi.org/10.1016/j.socscimed.2....
Leon, Chrysanthi S., and Corey S. Shdaimah. 2012. “JUSTifying Scrutiny: State Power in Prostitution Diversion Programs.” Journal of Poverty, 16:250–273
Morgen, Sandra, and Lisa Gonzales. 2008. “The Neoliberal American Dream as Daydream: Counter-Hegemonic Perspectives on Welfare Restructuring in the United States.” Critique of Anthropology 28, no. 2: 219–36.
Savage, Andrea, and Lisa A. Russell. 2004 “Tangled in a Web of Affiliation: Social Support Networks of Dually Diagnosed Women Who Are Trauma Survivors.” Journa
Knight, Kelly Ray, addicted. pregnant. poor.
Durham, NC: Duke University Press, 2015
Reviewed by Darra Rochelle Crouch
Kelly Ray Knight’s “addicted. pregnant. poor.” provides a compelling narrative ethnography examining the lives of the women living and working in the daily rent hotels of the Mission District of San Francisco. Intimate and brutal at times, Knight is frank and unflinching in her writing. Knight has not written a typical ethnography. What makes this book exceptional is Knight’s ability to weave the gut-punching exposure of social and political failures, next to her thoughtful self-aware discourses where she questions her own anthropological practice. Knight calls out the vulturistic aspects of the ethnographer, but she reminds the reader that it is not the vulture who kills their prey. (pg. 23). The real killer, as Knight illustrates, is the slow-moving and destructive power relationships that exist in between the world of the addicted pregnant and poor women that we meet in the day rent hotels of San Francisco and the world everywhere else.
Knight steps away from the high tower of academia and inserts herself into the narrative she composes. She is unafraid to share her own emotions about her experience and the way it pressed into her on a personal level, while still delivering a deep and wide theoretically salient work. Knight’s capacity as a researcher and her ability to communicate across a broad spectrum of institutional, organizational, and forbidden worlds, is made obvious throughout the book and her field notes provide an almost animated quality to each chapter. Translating her findings into a piece of scholarly work that does not feel overly filled with jargon, Knight provides essential information about the social, economic, political, public health, gendered, sociological, and critical nature of her study. The chapters and passages do not trip or stumble as they shift between the painful and brutal world of the daily rent hotels, the sober interactions with clinicians and public support workers, and Knight’s own musings about where she herself fits into the story.
The dichotomies that addicted, pregnant and poor women confront regularly represent a broad theme throughout the book. A common thread seen often in poverty research is the concept of the “deserving versus the undeserving” poor. This discriminatory practice is often reserved for populations of color, especially women, but Knight’s study, shows that the morally righteous are happy to discriminate across racial lines when women are pregnant and addicted.
Welfare qualifications have included some form of social control of women’s behavior for a long time. (Katz PPT) The women in Knight’s study face discrimination based upon their deviant behavior, specifically, drug use, the unstable living situation as well as involvement in sex work. Knight demonstrates, as so many other studies have, that welfare reform and the multiple changes since the original act in 1996, may very well have taken people off the welfare rolls, but only to leave them in situations that are worse, not better. (Gutman, Ketterlinus, and Mclellan. 2003.) The social safety net, in its current neoliberal form, has become a subtle system of “forced” coercion, in which non-compliance triggers punishment. The promotion of self-reliance in a system that points you towards choosing a rock or a hard place as your only two options for success will never be a winning program, no matter how much the policymakers congratulate themselves. (Morgen and Gonzales. 2008.) The fragility of trying to maintain self-reliance on a mid-20th century minimum wage paycheck, in the 21st-century world, does not require a degree in economics to understand. Yet the past decades of policy expect the people of this country to simply look the other way and accept the language about who is deserving.
While the efforts to have us believe that there exists, a newly minted cohort of self-sufficient citizens fresh off the welfare rolls on a regular basis may not be the worst crime of the neoliberals, it is undoubtedly the most tone-deaf. (Morgen and Gonzales. 2008.) Not only has poverty increased under these policies, but the middle class has all but disappeared, and the population living in deep poverty has expanded. Knight may not directly address welfare head-on, like Edin and Shaefer’s “ 2.00 a Day, Living on Almost Nothing in America” or even Katz’s “Reformed American Dreams,” but she doesn’t have to, her subject matter is a direct result of these policies.
In the most extreme poverty, even the tightest relationships are under tremendous strain. Circumstances of poverty create scenarios that weaken every area of Maslow’s hierarchy of needs. The addicted pregnant and poor women of the mission district show the ways that long stretches of this kind of living push people into the margins. For many of the women Knight works with, trauma begins in their own families, often at a very young age. (Savage and Russell. 2004) The outcomes of sundered lives may not always result in stories like the women in Knight’s book, but it is not uncommon to see how breakdown of early family relationships play a part in the inability to create meaningful relationships and the continued patterns of harm and mistreatment. Networks of the other women in the day rent hotels or other areas of street life can feel like a support system that the addicted, pregnant and poor women have, but typically, it is the network of people on the street that make it harder to escape. (Walsh et. al 2014)
Once separated from a secure form of housing, a stable family unit, fictive or otherwise, vulnerability and dependency is a constant threat. No one wants to be in that situation, and the women who live in the daily rent hotels, fight the worst living conditions every day and work to earn their rent, for just the slimmest margin of security and have to wake up and do it all over again the next day. Addiction and pregnancy are only two of several physical and mental issues that are part of the daily needs of the women in the day rent hotels cope with daily. The struggle to find and access proper help, the fight against wanting help, the fear of institutions, and the convoluted and disorganized thinking (pg. 194) creates additional barriers that often make getting through each day much more challenging than it already is. (Hansen, Bourgois, and Drucker. 2014)
The need for access to healthcare and housing security as a result of pregnancy presents Knight with a direct link to the complex ways in which the women are at the mercy of a system that judges them as morally bankrupt. (Leon and Shdaimah. 2012) Knight is able to speak with many of the “neurocrats” or advocate/bureaucrats (pg. 103) who help the pregnant, addicted, and poor women get the benefits they need. Some of the changes to welfare since 2000 have made changes to the qualification for certain SSI benefits. These “neurocrats” assist women in getting through the paperwork in such a way that prioritizes their mental health diagnosis so that they can qualify for the benefits.
The permanent “label” of a mental health disorder attached to one’s record is something that gives pause. How will this affect the future? Will this diagnosis become a scar, a permanent mark on the record of their failure, rather than a pathway towards receiving help? Will having this mental health diagnosis change the way authorities see a potential mother on paper? Even though many of these women are using drugs well into their pregnancies, they still anticipate wanting a relationship with their babies. It is natural to wonder how a mental health diagnosis will make them look as a mother.
The weight of this reality is something that Knight feels, she describes a conversation with a good friend, associate, and “long time interlocutor” who asks her about her feelings when she is with these women as they are using drugs while pregnant, Knight confesses, rhetorically, that she would like to kill them. Still, Knight is not a killer, no, she is just a vulture. (pg.231)
Having spent more than a decade doing outreach with the addicted populations in the San Francisco metro area, Knight is at ease with this understanding of how addicts behave and talk, her casual conversations with these women speak to her lack of judgment. The candid nature in which Knight’s subjects behave with her, make it clear that they feel comfortable and at ease. Knight captures the traumatized, demoralized, and criminalized victims who are frequently incapable of seeing far enough into the future to understand that there is an alternative to what is happening.
Compartmentalized by temporal frameworks, is one of the ways Knight uses to describe the lives of the addicted pregnant and poor woman. . Knight discusses the following frameworks for “time” in the lives of these women; addict time, hotel time, pregnancy time, jail time, treatment time, epidemiological time, biomedical time, memorial time, and lifetime. These time frameworks are both physical and mental, real and conjured, and each contributes to the disordered way these women live their lives. Yet, these temporal frameworks, additionally serve to provide the only sense of actual order for many of these women.
So much of what Knight punches at throughout the more narrative aspects of this ethnography feels to me like the binary ideas of Claude Lévi-Strauss’s adaptation of Structuralism. Knight presents you with these creations generated out of a response from the growing homelessness in San Francisco; the private daily rent hotel and the government-sponsored Single Room Occupancy (SRO) hotels. Structurally both hotel options may have started with the same purpose; however, for the women in her book, Knight illustrates how these binary options deliver another rock and hard place option for many women living on the razor’s edge. The government-sponsored option is a safer option, and it provides freedom from many of the injustices the women face at the daily rent hotels. However, the government-sponsored SROs are strict, you must pay rent one month in advance, often there are waiting lists, and SRO means what it says. Some may have curfews, there is less freedom, and Single Room Occupancy means what it says. The daily rent hotels offer a kind of day to day freedom that is sometimes easier to handle mentally and emotionally when your minds can only think as far as the next hit. The choice can be difficult.
A macro-level dichotomy that Knight points out is the view that the women in the daily rent hotels are both victims and perpetrators. Closely connected to the idea of the deserving and undeserving poor, the embodiment of both victim AND perpetrator for the pregnant addicted women presents a unique and challenging problem sociologically. The public’s mistaken understanding that anyone would choose to become an addict is problematic; one cannot possibly dictate rules about something of which they do not know. The “welfare to work” part of the welfare reform act has done nothing to help women “get back to work” in any meaningful way. The neoliberalist agenda, which promotes this work first ideal, does not seem to have any interest in the actual success rate for any of the people they claim to be helping. (Leon and Shdaimah 2014). When challenged regarding the number of people who are still suffering under the current policies, lawmakers are very quick to assign blame to the victims for being lazy.
Organizations like Project Prevention takes advantage of these vulnerable populations, by offering cash to women who are willing to consent to long term or permanent sterilization. This type of stratified reproduction (pg. 153), a horrifying specter of eugenics, and yet there is something fantastically sellable about Project Prevention’s package. At a minimum, the concept of getting paid to use contraception seems more empathetic than the welfare policies that currently exist.
That said, I need to express that even typing those words made me feel dirty. The exploitation of an addict’s need for money presents a challenge to my understanding of ethics. Expressly because, as a sober addict myself, I know how the addict’s mind works.
But I am not surprised that organizations like Project Prevention exist. The marketability of Project Prevention’s tactics and the current neoliberal policies are highly appealing to a specific sector of the population. But none of the practices of the “welfare to work” policies and how they are structured are based on evidential research, the methods of the neoliberals are based only on confirmation bias and a feedback loop of rhetoric. ( Morgen and Gonzales. 2008) Like so many aspects of the lives of the addicted, pregnant, and poor woman, everyone has an opinion, and many people are not afraid to tell you what they think is best. No one ever thinks to ask the women who are living in the conditions of being poor and addicted and pregnant what they think.
Knight shows all this complex and emotionally intricate subtext by using her field notes as a preface to each chapter and interjecting her person as a character as part of the narrative. By providing so many professional and clinical voices of the people who work in the world that the pregnant addict and poor women travel in, Knight provides an essential read for sociology and anthropology students as well as anyone interested in gender issues or policy. Having gone with Knight on this journey, I feel armed with a perspective that is clear and informed and rooted in an even-handed balance of academia and humanity. What researcher would not want to give that gift to their reader?
REFERENCES
Amundson, Kalynn, Anna M. Zajicek, and Brinck Kerr. 2015. “A Social Metamorphosis: Constructing Drug Addicts From the Poor.” Sociological Spectrum 35, no. 5:442–64.
Gutman, Marjorie A., Robert D. Ketterlinus, and A. Thomas Mclellan. 2003. “Characteristics of Substance Abusing Women on Welfare: Findings from the Evaluation of CASAWORKS for Families Pilot Demonstration.” Evaluation Review, 27 no. 6: 597–628.
Hansen, Helena, Philippe Bourgois, and Ernest Drucker. 2014 “Pathologizing Poverty: New Forms of Diagnosis, Disability, and Structural Stigma Under Welfare Reform.” Social Science & Medicine, 103: 76–83. https://doi.org/10.1016/j.socscimed.2....
Leon, Chrysanthi S., and Corey S. Shdaimah. 2012. “JUSTifying Scrutiny: State Power in Prostitution Diversion Programs.” Journal of Poverty, 16:250–273
Morgen, Sandra, and Lisa Gonzales. 2008. “The Neoliberal American Dream as Daydream: Counter-Hegemonic Perspectives on Welfare Restructuring in the United States.” Critique of Anthropology 28, no. 2: 219–36.
Savage, Andrea, and Lisa A. Russell. 2004 “Tangled in a Web of Affiliation: Social Support Networks of Dually Diagnosed Women Who Are Trauma Survivors.” Journa
August 6, 2025
Well, I probably wouldn't recommend this book to June Cleaver. Maybe if she had her smelling salts on hand.
Yes, in an ideal world... mother's intuition would kick in at the moment of conception, the prostitute struggling with addiction would immediately abandon her crack pipe or needle and, oh what the heck, her trick would turn out to be Richard Gere!!! They'd drive off into a well-lit sunset with their newborn in a drop-top Mercedes. Or a drop-top Porsche. Can't remember which.
I mean.. i'm sure that's happened to *someone* before?? 🤷♀️ But most people don't live in an ideal world, and definitely not the addicted sex workers living in daily-rent hotels who are profiled in this book.
Don't get me wrong, I felt angry at the women plenty of times when I was reading-- for continuing to use, for continuing to fail to show up to court dates and appointments or follow through on promises that would help them regain custody of their kid. I think frustration is a natural response to that, but it has to be tempered with a realistic understanding of the nature of what the author, Kelly Ray Knight, and others have referred to as a "chronic relapsing brain disease."
To give you a useful comparison, recently I read a different book ("The Sea of Peroxide" by Bruce H. Wolk) written by a former EMT and later a paramedic who worked during the early years of the AIDS epidemic. He often dealt with heroin injectors who were either dying of AIDS or still continuing to use and share needles despite the immense risk of contracting what was then a nearly 100 percent fatal and highly stigmatized disease. I sincerely don't believe anyone would choose to do that unless their rational brain was significantly, intensely compromised by addiction. We all have willpower, true, but willpower has to battle it out with a brain that has literally been rewired to choose the drug first.
It may not be pretty, but I realized while reading this book that the same rule applies to women in active addiction who discover they are pregnant. How they would otherwise respond to the prospect of becoming a mother under healthy circumstances is drastically warped by the reality of addiction. Kelly even references animal studies that have been done (she didn't say specifically what kind of animal, I'm guessing mice) which found that, when given cocaine, the animals stopped sleeping and eating in favor of receiving more cocaine, and they kept doing this until they all died.... I guess now I get where some of those Peta activists might have been coming from btw. 😮😬
Anyway, it explains so much of the behaviors you see from the women. I can't find the exact quote, but there's a social worker or healthcare provider of some sort who makes an observation about how often women in active addiction are genuinely shocked and devastated when they lose custody of their child. The social worker/healthcare provider would think "come on, you had to know this was gonna happen," but the women were genuinely shocked. That's how much they had compartmentalized their addiction. Denial was common and manifested in many different ways. Denial is a necessary survival strategy in active addiction.
And the really heartbreaking thing is, as clear as it is that the women aren't in any condition to be there for their children, the desire to be able to be a good mother is often very clear among the women. One of them, who had relinquished custody of her son to an aunt, purchased books for her little boy whenever she had the extra money and carried them around from hotel to hotel, from sleeping on the street and back to the hotel again. When the aunt finally agreed to bring her son to see her, she excitedly ran back up the stairs to retrieve the books from her room. Of course when the aunt and son left she returned to her drug use... but that's why it's heartbreaking. She clearly wants to change but is in too deep to live the life she wants.
Speaking of the hotels... So, the author did her research from 2007-2011, if I recall correctly, at a time when San Francisco's mission district was in the midst of gentrification. At that time (I'm not sure how much has changed since then) there were quite a few daily-rent hotels that catered to immigrant families, the working poor and to addicts. And they apparently functioned as "de facto brothels" for addicted women, even addicted pregnant women!
This blows my mind: the owners of the hotels were able to get away with 1.) charging the women arbitrary fees. If they saw the woman had sixty dollars in her purse, they'd charge her the rate and then tack on fees to bring the total up to $60. 2.) forcibly evicting the women regardless of their ability to pay after 21 days so that the women couldn't claim tenancy rights and get a reduced monthly rate. 3.) making the women's johns pay the hotel a fee to enter the premises. 4.) harassing the women into having sex with more clients to pay off debts. 5.) charging exorbitant rates for rooms that I can't believe weren't shut down by the health department AGES AGO. We're talking bed bugs, holes in the floor, chairs with the stuffing ripped out of the cushions, blood stains on the walls. The works.
Nevertheless, the women generally accepted this arrangement, which allowed them to curry favor with the hotel owners-- if you got on their good side, they'd let you slide on your debts a little longer or watch your stuff for you when you got evicted from your room and went off to hustle up some dates to pay them for another night. It's remarkable how quickly something abnormal can become normalized to you.
So,.. imagine this being your daily life and then finding out you're pregnant in the midst of all of it. I get why so many of the women reacted to their pregnancy with denial (that, and the fact that opioid use apparently causes frequent menstrual delays). There were so many forces that combined to keep the women stuck in a toxic cycle, of trying to manage drug cravings with mental health issues and daily demands for basic necessities alongside arbitrary fees. Even when they tried to get help (which seems to have been limited back then. From what I read in other books, it seems like accessing rehab treatment was a lot more difficult for addicts in the 90's and 2000's, unless maybe they had someone to bail them out financially), they were met with bureaucratic red tape.
Here's a description Kelly offers of the bureaucratic maze available to these women at the time: "This was the paradox: if a woman could successfully manage the requirements of the methadone maintenance program, she became a poor candidate for residential treatment, because she was too stable. Therefore, she had to join waiting lists for low income housing, as opposed to "supportive housing," which is frequently allocated for single adults with no children and serious mental and physical health problems. Low-income housing waiting lists often extend beyond the life of a pregnancy. A CPS case is then automatically initiated because of the woman's housing instability."
Yeah, it's a lot to navigate,. Nevertheless, I can't find the exact quote (I'll edit it in if I find it), but twice in the book a clinician or social worker makes an observation about a client who came in in the midst of their addiction, pregnant and strung out, and was given chance after chance after chance after chance to clean up and reunite with their child. Just when the clinician or social worker had dismissed the client as a lost cause, she'd come in strung out once again. But this time something different would happen. She'd follow through this time, she'd make her appointments, she'd regain custody, and she'd still be sober and living with her kid several years later. To be clear, sobriety amongst these women was hard to come by, and was often forced by institutionalization. sobriety rarely lasted more than a few months, or a year maximum. So to achieve multiple years speaks volumes and deserves tremendous respect. In any case, the message from the anecdotes of the clinicians is clear: never give up on a person struggling with addiction.
Okay, now that I have described the meaningful lessons I learned from the book, let me say why I'm giving it only three stars lol: I think this book was probably written for a specific, specialized audience: it's mostly pages upon pages of dry academic theorizing that I honestly struggled to have the patience for, and sometimes couldn't make heads or tails of. That said, such theorizing (even if it often comes across to me as stating the obvious, but just in a very overly convoluted and jargon-heavy way) is probably demanded for this kind of publication, and is probably deeply appreciated by other readers. So I get it. So even though I found some of it to be about as exciting to read as an engine manual 😂, the book still offers a lot of valuable information about the lives of its subjects, so I recommend it! Just be prepared to put up with a lot of heavy theorizing between more interesting anecdotes and so forth. 😂
Yes, in an ideal world... mother's intuition would kick in at the moment of conception, the prostitute struggling with addiction would immediately abandon her crack pipe or needle and, oh what the heck, her trick would turn out to be Richard Gere!!! They'd drive off into a well-lit sunset with their newborn in a drop-top Mercedes. Or a drop-top Porsche. Can't remember which.
I mean.. i'm sure that's happened to *someone* before?? 🤷♀️ But most people don't live in an ideal world, and definitely not the addicted sex workers living in daily-rent hotels who are profiled in this book.
Don't get me wrong, I felt angry at the women plenty of times when I was reading-- for continuing to use, for continuing to fail to show up to court dates and appointments or follow through on promises that would help them regain custody of their kid. I think frustration is a natural response to that, but it has to be tempered with a realistic understanding of the nature of what the author, Kelly Ray Knight, and others have referred to as a "chronic relapsing brain disease."
To give you a useful comparison, recently I read a different book ("The Sea of Peroxide" by Bruce H. Wolk) written by a former EMT and later a paramedic who worked during the early years of the AIDS epidemic. He often dealt with heroin injectors who were either dying of AIDS or still continuing to use and share needles despite the immense risk of contracting what was then a nearly 100 percent fatal and highly stigmatized disease. I sincerely don't believe anyone would choose to do that unless their rational brain was significantly, intensely compromised by addiction. We all have willpower, true, but willpower has to battle it out with a brain that has literally been rewired to choose the drug first.
It may not be pretty, but I realized while reading this book that the same rule applies to women in active addiction who discover they are pregnant. How they would otherwise respond to the prospect of becoming a mother under healthy circumstances is drastically warped by the reality of addiction. Kelly even references animal studies that have been done (she didn't say specifically what kind of animal, I'm guessing mice) which found that, when given cocaine, the animals stopped sleeping and eating in favor of receiving more cocaine, and they kept doing this until they all died.... I guess now I get where some of those Peta activists might have been coming from btw. 😮😬
Anyway, it explains so much of the behaviors you see from the women. I can't find the exact quote, but there's a social worker or healthcare provider of some sort who makes an observation about how often women in active addiction are genuinely shocked and devastated when they lose custody of their child. The social worker/healthcare provider would think "come on, you had to know this was gonna happen," but the women were genuinely shocked. That's how much they had compartmentalized their addiction. Denial was common and manifested in many different ways. Denial is a necessary survival strategy in active addiction.
And the really heartbreaking thing is, as clear as it is that the women aren't in any condition to be there for their children, the desire to be able to be a good mother is often very clear among the women. One of them, who had relinquished custody of her son to an aunt, purchased books for her little boy whenever she had the extra money and carried them around from hotel to hotel, from sleeping on the street and back to the hotel again. When the aunt finally agreed to bring her son to see her, she excitedly ran back up the stairs to retrieve the books from her room. Of course when the aunt and son left she returned to her drug use... but that's why it's heartbreaking. She clearly wants to change but is in too deep to live the life she wants.
Speaking of the hotels... So, the author did her research from 2007-2011, if I recall correctly, at a time when San Francisco's mission district was in the midst of gentrification. At that time (I'm not sure how much has changed since then) there were quite a few daily-rent hotels that catered to immigrant families, the working poor and to addicts. And they apparently functioned as "de facto brothels" for addicted women, even addicted pregnant women!
This blows my mind: the owners of the hotels were able to get away with 1.) charging the women arbitrary fees. If they saw the woman had sixty dollars in her purse, they'd charge her the rate and then tack on fees to bring the total up to $60. 2.) forcibly evicting the women regardless of their ability to pay after 21 days so that the women couldn't claim tenancy rights and get a reduced monthly rate. 3.) making the women's johns pay the hotel a fee to enter the premises. 4.) harassing the women into having sex with more clients to pay off debts. 5.) charging exorbitant rates for rooms that I can't believe weren't shut down by the health department AGES AGO. We're talking bed bugs, holes in the floor, chairs with the stuffing ripped out of the cushions, blood stains on the walls. The works.
Nevertheless, the women generally accepted this arrangement, which allowed them to curry favor with the hotel owners-- if you got on their good side, they'd let you slide on your debts a little longer or watch your stuff for you when you got evicted from your room and went off to hustle up some dates to pay them for another night. It's remarkable how quickly something abnormal can become normalized to you.
So,.. imagine this being your daily life and then finding out you're pregnant in the midst of all of it. I get why so many of the women reacted to their pregnancy with denial (that, and the fact that opioid use apparently causes frequent menstrual delays). There were so many forces that combined to keep the women stuck in a toxic cycle, of trying to manage drug cravings with mental health issues and daily demands for basic necessities alongside arbitrary fees. Even when they tried to get help (which seems to have been limited back then. From what I read in other books, it seems like accessing rehab treatment was a lot more difficult for addicts in the 90's and 2000's, unless maybe they had someone to bail them out financially), they were met with bureaucratic red tape.
Here's a description Kelly offers of the bureaucratic maze available to these women at the time: "This was the paradox: if a woman could successfully manage the requirements of the methadone maintenance program, she became a poor candidate for residential treatment, because she was too stable. Therefore, she had to join waiting lists for low income housing, as opposed to "supportive housing," which is frequently allocated for single adults with no children and serious mental and physical health problems. Low-income housing waiting lists often extend beyond the life of a pregnancy. A CPS case is then automatically initiated because of the woman's housing instability."
Yeah, it's a lot to navigate,. Nevertheless, I can't find the exact quote (I'll edit it in if I find it), but twice in the book a clinician or social worker makes an observation about a client who came in in the midst of their addiction, pregnant and strung out, and was given chance after chance after chance after chance to clean up and reunite with their child. Just when the clinician or social worker had dismissed the client as a lost cause, she'd come in strung out once again. But this time something different would happen. She'd follow through this time, she'd make her appointments, she'd regain custody, and she'd still be sober and living with her kid several years later. To be clear, sobriety amongst these women was hard to come by, and was often forced by institutionalization. sobriety rarely lasted more than a few months, or a year maximum. So to achieve multiple years speaks volumes and deserves tremendous respect. In any case, the message from the anecdotes of the clinicians is clear: never give up on a person struggling with addiction.
Okay, now that I have described the meaningful lessons I learned from the book, let me say why I'm giving it only three stars lol: I think this book was probably written for a specific, specialized audience: it's mostly pages upon pages of dry academic theorizing that I honestly struggled to have the patience for, and sometimes couldn't make heads or tails of. That said, such theorizing (even if it often comes across to me as stating the obvious, but just in a very overly convoluted and jargon-heavy way) is probably demanded for this kind of publication, and is probably deeply appreciated by other readers. So I get it. So even though I found some of it to be about as exciting to read as an engine manual 😂, the book still offers a lot of valuable information about the lives of its subjects, so I recommend it! Just be prepared to put up with a lot of heavy theorizing between more interesting anecdotes and so forth. 😂
March 8, 2018
I learned a lot and this was grim as shit. An excellent example of how the best ethnographies address very specific windows of experiences - e.g., drug-addicted pregnant women living in daily-rent hotels in the Mission District of SF and surviving on earnings from prostitution - yet also inform the reader on much wider questions (in this case, many pertaining to the welfare system, reproduction, treatment for addiction, housing rights, etc).
April 14, 2022
I am having a really hard time rating this book because of the following: On the one hand, it is a striking ethnography about pregnant women who are addicted to drugs as they navigate systems of oppression and stratified reproduction in San Francisco. On the other, however, I strongly question Knight's methodology as exploitative, in some cases non-consensual, and even veering on ethnoporn. This ethnography is meritorious in its discussions about unhoused communities, low-income housing, and SSI benefits. However, it is hard to look past her interactions with these women. And I view her ethnography, consequently, as extractive and vulturous. Righteous Dopefiend is a much superior ethnography that does encapsulate some of the same ideas and studies of addicted.pregnant.poor.
March 11, 2020
This is a grim and nuanced ethnography of a certain population (addicted, pregnant, poor women) who embody the intersection between various institutional, personal, and political failures. By inserting herself in this narrative, Kelly Ray Knight captures the ambiguities of witnessing the downward spirals of addicted pregnant women and forces us to watch with her. addicted.pregnant.poor highlights the many "times" that these women are allotted by way of their upbringing, socioeconomic circumstances, biological status, and mental illnesses. Time always seems to be running out as women are forced into a corner, being unable to access treatment that they need because of their victim-perpetrator status. Every seemingly intractable social issue should be examined as methodically and scientifically as this ethnography, where the ethnographer herself is a social actor.
May 8, 2023
The book was a good introduction to the topic of how pregnant addicts are treated by the healthcare system and by politicians as it goes through historical policy changes that impact addicts as a whole, but especially pregnant addicts. The book focuses on those in deep poverty - living in daily rent hotels and turning tricks for rent and drugs - and weaves in the stories of several women the author spent extended time with. The author does not really give us a final headcount of where everyone is years later except for a quick roundup without names which was sad. I got invested in the women and their situations so I wanted closure.
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May 18, 2025This book was recommended to me by a classmate. It’s a really interesting look into a public health study about women living in daily rent hotels in San Francisco. Most of these women have done sex work and been addicted to drugs at some point. This researcher focuses specifically on the pregnant women in this community. She does an excellent job diving into the different regulations and policies these women are subjected to.
May 9, 2023
Will not provide much review for this book because it is extremely hard for me to put into non-academic words how I felt about this book.
I will say that for anyone in anthropology who is focusing on women, pregnancy, addiction, or temporality studies, Kelly Knight's addicted.pregnant.poor is a must read.
I will say that for anyone in anthropology who is focusing on women, pregnancy, addiction, or temporality studies, Kelly Knight's addicted.pregnant.poor is a must read.
May 16, 2022
A powerful read about the plight of poor women in my home city. Learning about their experiences was eye-opening for me, and makes me determined to provide as much help as I can.
May 18, 2024
had to read this for school, good book
November 10, 2025
Good information that supported what I had known mostly. sadly, this is happening still across all cities in America. The researcher did an amazing job and showed great patience with the ladies
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February 24, 2016"The Mission District is very much a part of this narrative. Knight understands that individual women’s stories do not exist in a vacuum within the city; they speak volumes about the gentrification to the area unhinted at in the book’s title, the new people moving in, the private 'Google buses' that shuttle tech workers to their well paid jobs. ... This is a sobering, poignant ethnography that affords dignity to women whose lives are stripped of it by a system that has let them down." — Lisa McKenzie Times Higher Education
10/01/2015
"Addicted.pregnant.poor is a poignant read. Knight describes a range of conflicting emotions elicited throughout the course of her research. She depicts the ambivalent feelings of the array of professionals included in the study; her book evokes similar responses in the reader. Throughout the book, Knight poses reflexive questions for which there are no clear answers. While we see the perspective of pregnant addicts, as well as of those whose life’s work is to aid or manage them, the reader is left confounded regarding viable solutions.
Yet, with this thorough treatment of the issues faced by addicted pregnant women and their service providers, there is now more contextualized information for professionals and policy makers to work with. This book is a valuable resource for all stakeholders and should be a staple for everyone involved in work with pregnant addicts."
— Kalynn Amundson Journal of Children and Poverty
01/01/2016
10/01/2015
"Addicted.pregnant.poor is a poignant read. Knight describes a range of conflicting emotions elicited throughout the course of her research. She depicts the ambivalent feelings of the array of professionals included in the study; her book evokes similar responses in the reader. Throughout the book, Knight poses reflexive questions for which there are no clear answers. While we see the perspective of pregnant addicts, as well as of those whose life’s work is to aid or manage them, the reader is left confounded regarding viable solutions.
Yet, with this thorough treatment of the issues faced by addicted pregnant women and their service providers, there is now more contextualized information for professionals and policy makers to work with. This book is a valuable resource for all stakeholders and should be a staple for everyone involved in work with pregnant addicts."
— Kalynn Amundson Journal of Children and Poverty
01/01/2016
December 21, 2022
A challenging read as it is an ethnography of pregnant women who also have some form of addiction and sex work in San Francisco in the early 2000s. While the material was difficult to read, the themes shed light on the challenges of navigating the healthcare system and the struggles of leaving the situation. I would recommend this book to those who are interested in social services and public health as this ethnography shows the struggles certain populations face when they are addicted, pregnant poor.
July 25, 2016
Knights description of the differing "times" that women in addicted life face, ranging from "hotel time"--the need to hustle to make $50 rent or be evicted--to "addict time"--repeatedly searching for crack or heroin to satiate her addiction--or "pregnancy time"--her ever expanding belly be-spelling the ticking time bomb about to go off (p. 8-9).
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